Reduce the need for radiation therapy and surgery related to bone fractures and bone pain

How are bisphosphonates given?

Bisphosphonates are given once a month or every 3 months by vein (through an IV).

How is denosumab given?

Denosumab is given once a month as an injection (not an IV).

Side effects

In some people, bisphosphonates and denosumab can cause bone, joint or muscle pain [38-39]. Any of these side effects should be reported to a health care provider right away.

Some people who take bisphosphonates need to increase their intake of vitamin D and calcium. If you develop muscle twitching or increased anxiety, ask your provider if you should take supplements to keep your vitamin D and calcium levels up.

In rare cases, with either type of drug, a disorder called osteonecrosis of the jaw may occur [38-39]. Before you start treatment with bisphosphonates, it’s a good idea to have a dental exam [39].

Talk with your oncologist before getting any dental procedure while you are being treated with bisphosphonates or denosumab.

Diarrhea

Some chemotherapy and targeted therapy drugs can cause diarrhea. Bowel movements may become more frequent and/or looser and you may also have cramping and gas.

Some ways to manage diarrhea are listed below. Talk with your provider about which over-the-counter diarrhea medication to take (and take it as prescribed) or if you need prescription medicine.

Keep track of the number of bowel movements you are having. If you are having more than 4 loose bowel movements a day or the diarrhea does not improve after 2 days, let your provider know [41-42]. These are signs the diarrhea is serious and you need medical care.

If the diarrhea improves after a day or 2, you may begin eating small, regular meals again [41].

Fatigue

Fatigue is common with metastatic breast cancer and can greatly impact quality of life.

When fatigued, people feel tired and lack energy all of the time. Sometimes, even getting enough rest doesn’t help.

Your health care provider should check for signs of fatigue at each visit. He or she can help you find ways to manage it.

Many breast cancer treatments cause fatigue. Depression and trouble sleeping are other common causes of fatigue [43].

For some people, fatigue is caused by anemia (a drop in red blood cells).

Although it may seem hard during treatment for metastatic breast cancer, getting some physical activity may help reduce fatigue. Family and friends often want to help, but don't know how. For example, you may want to ask someone to be a walking partner.

If you feel overly tired or have trouble sleeping talk with your provider. Together, you can find the best ways to manage fatigue.

Anemia (low red blood cell count)

Chemotherapy destroys red blood cells in the body. This can cause anemia, which can cause fatigue.

Sometimes, anemia can be treated by increasing iron or folate in the diet. Severe anemia can be treated with a blood transfusion.

Growth factors, such as erythropoietin (Procrit, Epogen and Aranesp), can increase red blood cell count and reduce the need for blood transfusions. However, safety studies have raised questions about whether people with breast cancer should take these drugs (for more on these studies, visit the FDA website).

These drugs increase the risk of blood clots and stroke, and may shorten survival [45-48]. So, they aren’t recommended for the treatment of anemia after chemotherapy ends [45-48].

Palliative care and pain control

Palliative care

Although metastatic cancer cannot be cured, treatment may extend life.

The side effects of some therapies, however, can affect quality of life.

Reducing any cancer-related symptoms (called palliative care) should always be a part of breast cancer treatment.

Pain control is an important part of palliative care.

Pain control

Controlling pain and other symptoms should be part of standard care for everyone with breast cancer. It’s especially important for those with metastatic breast cancer.

Treatment may include pain medications and may target specific parts of the body.

Our Breast Care Helpline 1-877 GO KOMEN (1-877-465-6636) provides free, professional support services to anyone with breast cancer questions or concerns, including people with metastatic breast cancer and their families. Calls are answered by a trained and caring staff member Monday through Friday from 9:00 a.m. to 10:00 p.m. ET and from 6:00 a.m. to 7:00 p.m. PT. You can also email the helpline at helpline@komen.org.